No fail-safe test, no required system to prevent another E. coli outbreak

by KATE WINSTON

That which nourishes us destroys us

A small boy has what appears to be the flu, but suddenly he takes a turn for the worse–he has a high fever and there is blood in the toilet. The doctor tells his mother that the boy has a kidney problem caused by E. coli poisoning and there is no treatment except for dialysis and blood transfusions.

Investigators from the Center for Disease Control ask the mother to fill out endless question forms. Did he eat spinach, or a plethora of other fresh fruits and vegetables? She asks herself which of the healthy foods in the fridge could be the perpetrator.

She also asks what the government is doing to prevent children like hers from suffering. She searches the Internet, but she only finds stern letters from the Food and Drug Administration to the lettuce and spinach growers asking them to improve their practices. This hypothetical family shows the real problems that E. coli victims face.

Deadly silence

According to the Centers for Disease Control and Prevention, every year 76 million Americans suffer from food-borne illnesses. Of these, 325,000 are hospitalized and more than 5,000 die, said a report by the National Institutes of Health (link:) http://www.niaid.nih.gov/factsheets/ecoli.htm.

In January, the United States Government Accountability Office “designated the federal oversight of food safety as a high-risk area for the first time,” according to testimony to the U.S. House of Representatives. However, no new food safety legislation has passed, even in light of ongoing food product contamination. In addition, the testing methods used in the United States could miss up to one-quarter of the dangerous kinds of E. coli.

In January, the United States Government Accountability Office “designated the federal oversight of food safety as a high-risk area for the first time,” according to testimony to the U.S. House of Representatives.

Leafy greens fall into a precarious regulatory limbo between several agencies. The EPA is in charge of water quality, the U.S. Department of Agriculture regulates the animal pastures that often carry the bacteria, and the FDA regulates food product safety.

Water testing is currently up to local water quality control boards. The boards test for thresholds of fecal coliform, but they do not test for specific kinds of E. coli.

The EPA calls these thresholds Total Maximum Daily Loads (TMDL), and it defines how much pollution a water body can handle, said Elisabeth Morgan from the National Oceanic and Atmospheric Administration. The EPA can set a TMDL for anything it wants to, she said.

Unlike the process for meat inspections, there are no mandatory tests for vegetables. “The USDA looks at meat, and people assume that they are doing something for produce, but they are not because it is done by the FDA,” said Patty Lovera, assistant director of the consumer advocacy group Food and Water Watch.

With 20 E. coli outbreaks in the last 10 years, some feel it is time to overhaul the FDA’s procedures in the same way that USDA meat inspection became more stringent after E. coli outbreaks in the 1990s.

A new, unified agency on the horizon?

Some advocates think Congress should create a new agency that would monitor all aspects of food production. The Safe Food Act, first introduced by Sen. Richard Durbin (D-Ill.) in 2005, would ostensibly do just that. The bill was revived in the House on Feb. 16 by Rep. Rosa DeLauro (D-Conn.). However, it was referred to the Committee on Agriculture, not the Committee on Health.

A Safe Food agency would be a step forward since the FDA and U.S. Department of Agriculture have not always acted in the public’s interest, said Caroline Smith DeWaal, director of food safety at the Center for Science in the Public Interest (CSPI). “The FDA is a health agency, but it also has not always acted in the best interest of consumers,” she said. The FDA did not return a phone call for comment.

The U.S. Department of Agriculture inherently faces a conflict of interest, DeWaal said. “USDA wears two hats: its job is to inspect meat products, but its larger mission is to promote food products,” she said.

Lovera thinks that while the food industry already exerts some control over the U.S. Department of Agriculture, a new agency may be no different. Creating a new agency would be disruptive and expensive, so Food and Water Watch has not taken an official stance on the Safe Food Act, she said.

Agribusiness’ vested interests

The agribusiness sector certainly spends heavily on lobbying Congress. Since 1990, the industry has spent more than $396 million, according to the Center for Responsive Politics Web site at www.opensecrets.org. Since 2001, the current members of the House Committee on Health and the Senate Committee on Health, Education, Labor and Pensions have received a total of $5.8 million.

Consumer advocacy groups feel that they have been left out of the dialogue on the Hill. Last fall, CSPI petitioned the FDA to ratchet up regulation at the farm level at the same time that the Senate Committee on Health, Education, Labor and Pensions was holding hearings on the spinach outbreak. “Though FDA, state officials and several businesses are testifying, consumer groups and victims have been excluded from the committee’s deliberations,” the petition said.

The FDA sent warning letters to the spinach, lettuce and tomato industries in 2004 and 2005, according to Robert E. Brackett, director of the Center for Food Safety at the FDA. Brackett also emphasized the importance of the FoodNet and OutbreakNet programs, which are meant to track and limit, but not prevent an outbreak.

When outbreaks do occur, consumers are not the only ones to suffer. The government should repay spinach growers who were not implicated in the Sept. 2006 recall, said Robert Whitaker, president of MissionStar Processing in Salinas, Calif., in testimony to the Senate HELP committee. Rep. Sam Farr (D-Calif.), introduced the Spinach Research and Recovery Act of 2007, which would fund food-safety research and provide financial relief to growers after a FDA recall.

The success record of self-regulation

For many produce sellers and consumers, voluntary measures have fallen short in the past. In each of the two years before the recent outbreak, the FDA warned the leafy green industry to change their procedures.

In 2002, the California Department of Health Services (CDHS) began meetings with the leafy green industry to ask them to “step forward” to help prevent future outbreaks of E. coli contamination, according to Senate testimony by Kevin Reilly, deputy director of prevention services at CDHS.

“Unfortunately, these meetings did not result in the desired outcome and subsequent E. coli O157:H7 outbreaks have occurred,” he said. The CDHS did not return phone calls for comment.

Some think changes should begin at the local level. “I would like to see the states get into it at first just because the FDA is not ready to do this yet. They are lacking in resources,” Lovera said.

In response to a demand from major grocery stores, the spinach growers in California worked with the state government to create new standards for the handling of leafy greens. However, according to the certification agreement, the rules were written by the industry.

“The proposed agreement, which was created by the leafy greens industry and is being facilitated by CDFA, would utilize the inspection program to verify that leafy greens handlers are complying with their own standards,” the agreement said.
Tracking a killer

An E. coli O157:H7 outbreak last fall caused by contaminated spinach sickened 204 and killed 3 people, including a two-year-old boy in Idaho. E. coli O157:H7 has a dangerous reputation, yet there are other deadly strains on the loose.

Experts estimate there are about 100 strains of E. coli that make people sick, yet the tests that are widely used in the United States only look for one.

There are hundreds of kinds of E. coli and many of them are harmless or beneficial to humans. E. coli becomes dangerous when it is infected with a virus that carries the Shiga-toxin gene, and that could happen to any strain of the bacterium. Other E. coli strains, such as O26, O103, O111 and O145 can cause the same symptoms.

Non-O157 E. coli is believed to be responsible for almost one-quarter of E. coli illnesses in the United States. In a 2005 CDC study in ten states, non-O157 caused 146 illnesses and O157 caused 473 illnesses. FoodNet, the CDC program that conducted the survey, monitors only 15 percent of the U.S. population.

Worldwide, non-O157 is responsible for 20 to 70 percent of E. coli illnesses, according to a 1998 report by the World Health Organization. At that time, the WHO warned that it is a health threat and that “surveillance for non-O157 is almost non-existent.” This is partly because the tests for O157 have been in use for 25 years, and newer, more accurate tests are less common.
Tests of the future

Most E. coli tests look for a specific protein pattern that easily identifies the bacterium as O157. That type of test cannot catch the other strains of E. coli that carry the Shiga-toxin.

A polymerase chain reaction (PCR) test would be able to see the Shiga-toxin gene in any strain of E. coli. The PCR is also beneficial because one test can identify multiple pathogens at once, so vegetables could be tested for both E. coli and salmonella at the same time.

This test could be used at all stages of the process, from water and food to animal and human samples.

However, this test is relatively new and expensive. A Canadian biomedical company called Warnex has a PCR test that produces results in 18-24 hours. A testing system goes for about $50,000.

While Warnex only has a test for the O157:H7 strain, a knowledgeable operator could create a test to look for the Shiga-toxin gene, said Eileen Cole, an account executive at the company.

Other companies, such as Intralytix, hope to discover viruses called phages that would kill E. coli. Yet, like any good bacteria, E. coli can mutate very quickly. Therefore, a cocktail of different phages must be applied to the food, said John Vazzana, the president of the company.

While Intralytix’s phage technology is approved for use against Listeria bacteria on meat, more research is needed to know if it would be effective on produce, Vazzana said.

Developing an affordable, effective test will be essential to preventing E. coli outbreaks, said Kathleen Spiegel, a clinical science professor at Idaho State University. “Approaches focusing on one strain of E. coli will be doomed to failure,” she said.

And while the government and industry continue to ask regulatory and scientific questions, the mother of a sick child may not find the answers she is looking for.

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